Florida Blue and Orlando Health Create Accountable Care Arrangement

JACKSONVILLE and ORLANDO, Fla., Dec. 10, 2013 /PRNewswire/ — Florida Blue and Orlando Health Physician Partners have announced the execution of an accountable care agreement, which aims to improve the quality and efficiency of patient care in the Orlando area.

Starting on Jan. 1, 2014, the accountable care program will utilize a value-based compensation structure that i s intended to decrease medical costs and increase quality outcomes by rewarding the right combination of goals, including transparency, care coordination, consumer empowerment and lack of redundancy. – See more details at PR Newswire.com.

Study Looks at ACO Formation Drivers

An article in Physicians Briefing points to a study published in the October issue of Health Affairs that suggests that underlying provider integration in a given geographic region may be the key that drives the formation of Medicare accountable care organizations (ACOs),

The researchers found that a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups were key regional factors associated with ACO formation.

The study is available for purchase at HealthAffairs.org.

Should Health Care Systems Become Insurers?

A new article published in the Journal of the American Medical Association (JAMA) asks the question: Should Health Care Systems Become Insurers?

An introduction to the article explains that incentives under the Affordable Care Act (ACA) are spurring increasing numbers of health care systems to assume the risk of paying for patient care, blurring the boundaries between care delivery organizations and insurers. New arrangements such as bundled payments, value-based purchasing, and accountable care organizations (ACOs) transfer financial risk from payers to health care systems. The union of payer and care delivery functions may engender opportunities for health systems to invest in prevention and more comprehensive, coordinated, patient-centered care.

The entire article is available at JAMANetwork.com and is available to registered members.

CAQH CORE, the Quiet Side of the Affordable Care Act

With health care exchanges dominating the news with regard to the Affordable Care Act (ACA), another piece of the health care reform legislation that will affect more people than the individual mandate or the public exchanges is being implemented with much less fanfare and media attention.

Those are the sections of the law that require administrative simplification and the development of standards for financial and administrative transactions. Sections 1104 and 10109 of ACA will impact nearly everyone who uses, pays for or delivers health care.

Essentially these sections of the law are aimed at bringing the health care industry (hospitals, health plans and other stakeholders) to a place that the financial services industry has been for years. That is having universal standards in place that allow financial institutions to communicate with one another in the same electronic language. It is what allows someone to use an ATM at a bank branch or at a gas station.  Continue reading

BCBSM to Compare Michigan Hospitals Costs and Care

DETROIT—Blue Cross Blue Shield of Michigan, Blue Care Network, and the University of Michigan Health System have launched the Michigan Value Collaborative, an initiative aimed at helping hospitals across the state understand their practice patterns compared with their peers, better manage costs and improve outcomes for patients.

“This new initiative uses health care claims data to enable hospitals to see how they compare on the resources they use to deliver care to patients,” said David Share, M.D., M.P.H., senior vice president, Value Partnerships, Blue Cross Blue Shield of Michigan. “This initiative is unique in that it allows participating hospitals to see how they compare with other hospitals, and use that data to better connect their care practices and costs with outcomes. Hospitals will be able to adjust their practice patterns to benefit patients and the overall efficiency of our health care system.”

See the full story at BCBSM.com.

As Some Companies Turn to Health Exchanges, G.E. Seeks a New Path

Some major firms, like Walgreen, the drugstore chain, are giving those who qualify money to buy insurance on a private health exchange. In Cincinnati, General Electric is taking the opposite approach to reining in health care costs

One of the largest employers in the nation, it spends more than $2 billion a year offering coverage to 500,000 employees and retirees and their families. And it is using its considerable clout in places like this — where its giant aviation business gives it a major presence — to work directly with doctors and hospitals to improve care and reduce costs.

Over the last few years, G.E. has pushed for the creation of so-called medical homes, in which an individual medical practice closely coordinates a patient’s care by having access to all of the patient’s medical records.

In Cincinnati, about 118 doctors’ practices have converted to medical homes, and all five of the major health systems are making their primary care practices move in that direction. G.E. has also pushed for greater transparency of results.

See the full story at NewYorkTiems.com.



Payment Incentives Can Boost Care, but Long-Term Strategies Needed Acording to a new JAMA Study

Financial incentives can encourage physicians to provide higher quality care to their patients, but the additional money might not be enough to significantly improve care over the long term, according to a study published Wednesday in the Journal of the American Medical Association, the Los Angeles Times‘ “Science Now” reports.

The study found that the individual incentives — $2,672 per doctor on average — helped spur a significant change in the physicians’ performance. Meanwhile, group payments — $1,648 on average — and combined group and individual payments — $4,270 on average — did not lead to significant changes in performance (Evans, Modern Healthcare, 9/11).

Get more of the stpry at CaliforniaHealthline.org

Study Reveals Risk for Market Disruption with Move to Value-Based Care

JACKSONVILLE, Fla.–(BUSINESS WIRE)–Health plans and providers expect their participation in value-based care programs to more than triple in the next three to five years. For that growth to be successful, more than 90% of respondents from both groups agree they must automate the information exchange required by these programs. However, only a small percentage of providers and plans report having fully-automated capabilities in place – leaving a questionable gap in the current operational readiness of the market.

These findings and others are from a pair of recently-published research studies by Availity, a leading health information network. They shed further light on the need for automated information exchange solutions in the market to support emerging payment models, and call attention to the disruption the market may encounter if health plans and providers continue to rely on manual methods of exchanging critical data.

See the full story at Businesswire.com

United Healthcare Introduces Online Bill Payments

United Healthcare has introduced an online bill payment service that enables United members to pay their bills to healthcare providers by credit card or bank transfer.

United, which has integrated the online bill-pay capability with its claims processing system, is the first payer to supply a service of this kind, said Victoria Bogatyrenko, VP of products innovation for United, in an interview with InformationWeek Healthcare.

The significance of United’s move is that it provides a more efficient way for many providers, especially small physician practices and community hospitals, to receive payments from patients. Also, the approach makes it easier for patients to see what they owe and pay their bills to all of their doctors.

Se the full story at InformationWeek.com


UnitedHealthcare’s New Online Service Lets Consumers Pay Their Medical Bills Online and Better Manage Health Care Expenses

MINNETONKA, Minn.–(BUSINESS WIRE)–UnitedHealthcare has introduced a secure, online electronic bill-payment service that enables consumers to pay their medical bills and manage their health care claims and related expenses all from one location. The online service, known as myClaims Manager, is available to more than 21 million UnitedHealthcare plan participants nationwide.

The online feature helps consumers better manage their health-related finances by:

  • helping consumers to check claims for accuracy and resolve any discrepancies;
  • highlighting the current status of an individual’s deductible and out-of-pocket spending;
  • tracking medical expenses for tax reporting;
  • providing claim details with color-coded visuals that help consumers understand what they owe and why;
  • allowing consumers to make notes and flag claims for follow-up, as well as mark claims that they’ve already paid;
  • enabling consumers to pay their out-of-pocket expenses to care providers online from the site, simplifying the experience by managing their claims and payments all from one location; and
  • explaining health care terms in easy-to-understand language.

Read the full story here: http://www.businesswire.com/news/home/20130820005042/en/UnitedHealthcares-Online-Service-Lets-Consumers-Pay-Medical